Suture/button constructs have been used for fixation of ankle syndesmosis (U.S. Pat. No. 7,235,091), acromioclavicular (AC) joint fixation (U.S. Patent Appl. Publ. No. 2007/0179531) and more recently, for small joint surgery, such as bunion repair (U.S. Pat. No. 7,875,058), or lisfranc repair (U.S. Pat. No. 7,901,431). In these small joint techniques, the suture/button construct is passed through a passage or tunnel (for example, a drilled hole) by employing a needle that pulls the button and the attached suture through the passage or tunnel. Pulling of the needle through the passage or tunnel, and subsequently out the skin, may be difficult, however, in certain circumstances, such as hallux valgus correction and lisfranc ligament repair. In addition, proper positioning of the buttons (for example, of the oblong and round button of the suture/button construct) may be difficult when the buttons are pulled through with suture and needle.
An instrument for pushing the buttons and attached suture through the drilled hole (instead of having to pull them through using the needle) is described in U.S. Patent Appl. Publ. No. 2009/0043318, the disclosure of which is incorporated in its entirety herewith. As detailed in U.S. Patent Appl. Publ. No. 2009/0043318, the shaft of the instrument is provided with an engagement mechanism that securely engages a corresponding structure (for example, a cavity or recess) of the button of the suture/button construct. The cavity (recess) of the button has a diameter about equal to the diameter of the shaft to allow a tight fit of the button to the applicator during advancement of the button through soft tissue or bone hole. The button is secured to the instrument with suture.
An instrument that would be able to push the button and attached suture through the drilled hole, and allow the button to be screwed and unscrewed from the instrument without causing rotation of the button, is needed. Also needed are methods of positive control and release of buttons used in surgical procedures, particularly in orthopedic procedures.